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chest pain

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AAAAA

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Topics: 159
Posts: 2013

Mar 05, 2007 - 2:12 PM

A 69-year-old man is evaluated in the emergency department for the acute onset of substernal chest pain radiating to the left arm. The patient is a former smoker with a history of hypertension.
On physical examination, he is diaphoretic, with a blood pressure of 210/95 mm Hg in the right arm and 164/56 mm Hg in the left arm, a pulse rate of 90/min and regular, and a respiration rate of 20/min. There is dullness half way up the right posterior thorax and a 2/6 diastolic murmur at the right upper sternal border. Electrocardiogram shows sinus rhythm with a 2- to 3-mm inferior ST-segment elevation.
Prior to additional diagnostic tests, which of the following is the most appropriate initial medication?
A Aspirin

B Intravenous heparin

C A thrombolytic agent

D A Î²-blocker

E An angiogensin-converting enzyme inhibitor